The three tiers of screening for sarcoidosis organ involvement.

Sarcoidosis may involve any organ in the body. Organ involvement with sarcoidosis may go undetected. This manuscript addresses a suggested approach to screening for sarcoidosis organ involvement. As sarcoidosis organ involvement may never cause symptoms or clinical problems, it is not always necessary to expend the time or expense to detect all organs involved with sarcoidosis. On the other hand, some forms of sarcoidosis organ involvement may have potentially severe consequences such as permanent vision impairment from eye sarcoidosis and sudden death from cardiac sarcoidosis. We believe it useful to describe three tiers of screening for sarcoidosis organ involvement. The first tier of screening involves eliciting a medical history and performing a physical examination. This is a useful screen for all organs. The second tier of screening involves performing specific laboratory tests to search for specific sarcoidosis organ involvement, even if there is no clinical sign or symptom to suggest involvement of that organ. Such screening is only recommended for a limited number of specific organs. The third tier of screening is complex and involves the performance of multiple tests/algorithms or examinations by subspecialists to search for specific organ involvement. The third tier of screening is used to evaluate eye sarcoidosis, vitamin D dysregulation associated with sarcoidosis, and cardiac sarcoidosis. It is hoped that this approach to screening for sarcoidosis organ involvement will be a springboard for rigorous examination of this process that is likely to benefit sarcoidosis patients.